Nebraska nursing homes bash new 'fundamentally flawed' regulations

“It's absolutely fundamentally flawed, because that's not how long term care facilities operate,” said Tim Groshans, owner of three Nebraska nursing facilities.

He’s talking about a new rule released by the Center for Medicare and Medicaid Services.

Intended to improve patient care in long-term care facilities, the regulation would require nursing homes to staff a registered nurse for 24 hours a day.

Groshans said it would give them less flexibility to accept patients and adjust staffing levels to fit patient needs.

Nebraska nursing home administrators and CEOs across the state fear what the new regulations proposed by the federal government could mean for their communities.

Groshans said the new rule won’t accomplish the goal of improving patient care.

“I actually think it runs a high risk of doing just the opposite,” Grohans said.

“Any policy that — really looking at rural facilities —- demands more money to hire the highest paid, most difficult area to hire right now and takes away potentially the number of nurse aides and med aides could have a detrimental effect in long term care facilities,” he said.

RNs oversee the quality care in nursing homes. The bedside care is typically provided by nurse aides and med aides. Groshans said the more nurse aides and med aides a facility has, the more effective its care will be.

As it stands now, nursing homes are only required to have an RN on-site for eight hours per day.

Licensed practical nurses, or LPNs, oversee a facility’s care when an RN isn’t working.

Groshans said RNs have more training and in turn are paid a higher wage, when you can find them.

“But we've been fighting a lack of RNs for a number of years. And now there's a policy that seems to think that's gone and that they're just aplenty and you can find them. That's not reality,” Groshans said. “It is extremely difficult. And I'll just say there's a number of rural long-term care facilities that will not survive this. If this goes through, they won't survive.”

He said an experienced LPN can provide similar levels of oversight and administrative knowledge to a nursing home.

CEO and president of the Nebraska Health Care Association, Jalene Carpenter, said the nursing shortage is pretty severe.

“There are over 1300 RN openings in the state of Nebraska. And that's without a minimum staffing requirement,” Carpenter said.

There are six counties in Nebraska with no registered nurse at all, according to the Nebraska Center for Nursing. A handful of counties only have one RN working in its area.

Nebraska is on pace to be 5,435 nurses short by 2025, according to the Nebraska Nursing Workforce Shortage.

The state legislature appropriated $3 million over each of the next two fiscal years to train more registered nurses in the state.

It’s not just rural nursing homes in Nebraska that have concerns.

At least one metro area nursing home administrator said his facility won’t be able to find enough RNs to comply with the new mandate.

With the burden of hiring more RNs, John Turner of Newport House in northwest Omaha, said someone will have to bear those costs.

“Who am I going to pass that cost on to? Because we're basically underfunded under Medicaid. So we're not funded to an appropriate level there. Medicare has a set costs. So basically, I'm passing my cost off to private pay individuals,” Turner said.

About half of his patients are on Medicaid, he said. Those Medicaid reimbursement rates could be even more slim for rural nursing homes.

Funding for the health care program largely comes from the state.

Carpenter said Medicaid patients come out as a loss for the nursing homes.

“If you look at what it costs to care for a resident versus what a nursing home is paid, on average, they're not covered by roughly $49 a day,” Carpenter said.

Access to care becomes the barrier for low- or fixed-income Nebraskans. That’s especially true in rural areas where margins could be even more thin.

The Nebraska Health Care Association has received about 300 comments from its representative nursing facilities on the issue. Carpenter said the actual number could be closer to 500 because facilities can submit comments directly to CMS as well.

As the proposed rule is written now, there’s a three-year implementation plan for rural facilities and a two-year expectation for urban nursing homes.

Carpenter said the extra year won’t make a difference for those rural facilities.

In addition to the 24/7 RN staffing rule, the proposal includes three other requirements, according to NPR: (1) Each patient would receive 33 minutes of a nurse's attention per day; (2) about 2.5 hours of a certified nursing assistant's care every day; and (3) the facilities should have at least one certified nursing assistant for every 10 residents.

The union representing nursing home workers applauded the Biden-Harris administration for answering the call for better conditions in nursing homes.

In part, AFL-CIO President Liz Shuler wrote in a statement, “This proposed regulation is about improving the quality of care and jobs in nursing homes, but its importance goes beyond this one sector.”

Shuler continued, “corporations long have prioritized cutting costs rather than shoring up safety for health care workers and the people who rely on these life-sustaining services. Workers continue to bear the brunt of the care economy crisis and are stretched thin by a severe lack of resources. Care workers are egregiously underpaid and deeply undervalued, and it’s past time they receive good pay and dignity on the job.”

According to Carpenter, the rule is out of touch with needs in the Midwest. She said the rule is “trying to have a one foot one-size-fits-all solution that somehow can encompass our entire country.”

Emphasizing the uniqueness of rural health care’s presence in Nebraska, Carpenter said, “this was done by people who sit at a desk in Baltimore, and not necessarily by people who are boots on the ground and understand what's happening all across the country.”

The proposal remains in a comment period until Nov. 6. Organizations like the Nebraska Health Care Association are taking comments from its members to send over to Washington D.C..

CMS has received about 16,000 comments, according to Carpenter and is required to read and review them all.

Several different things could happen after it reads every comment. The mandate could be adopted as is, amended or struck down.